Repeat testing on the Edinburgh Depression Scale and the HADS-A in pregnancy: differentiating between transient and enduring distress

Abstract

Background: The Edinburgh Depression Scale (EDS/EPDS) is routinely used in many clinical services to screen for probable distress in antenatal and postnatal women. Typically a single administration of this scale results in a referral to a specialist mental health service if the woman scores above the service's cut-off score on the measure - that is, scores 'high'. A few postnatal studies have shown, however, that many women when re-tested just a few weeks later no longer score 'high'. This study explored this phenomenon in a sample of pregnant women, using both the EDS and an anxiety self-report measure (Hospital Anxiety and Depression Scale - Anxiety subscale: HADS-A).

Method: 164 English-speaking pregnant women attending a local public hospital's antenatal clinic for their first appointment participated. At this appointment they completed the EDS and the HADS-A, and predicted how they might be feeling in about two-week time. Approximately two weeks later they were interviewed by phone and again completed the EDS and the HADS-A, and answered questions about possible mood changes.

Results: Regardless of which of several cut-off scores on the EDS or HADS-A was used to define 'high' scorers, approximately 50% (±6%) of women scoring high at their first appointment on either measure no longer scored 'high' two weeks later. Common reasons given for their mood improvement included reduced morning sickness, reassuring results from routine tests (e.g., ultrasounds), fear of miscarriage subsiding, and a sense of reassurance following their hospital visit. Many of the women were accurate in predicting at their first appointment that they would be feeling better within a few weeks.

Limitations: The administration procedure for completion of the measures on the two occasions was different. Women initially completed the measures by hand, and on the second occasion over the phone.

Conclusion: Half the women screened as having emotional distress - that is, scoring 'high' on self-report mood measures (i.e., EDS and HADS-A) - during their first hospital visit in pregnancy are likely to have transient distress for predictable reasons. Referring women to specialist mental health services based upon just one administration of these measures will therefore result in a large number of unnecessary referrals, thus possibly overstretching the resources available. We therefore believe that when women score high on a self-report mood measure, enquiring as to why this is the case, and about whether the woman expects to feel differently in a few weeks time, together with a second administration of the measures in a few weeks is a better practice, unless there are good clinical reasons to do otherwise. In addition, studies reporting prevalence rates of perinatal distress should not simply use a one-off administration of a self-report mood scale to state the probable rate of disorders or distress.